Information Exchange Capabilities Research Articles

Social CRM Strategies: A Key Driver of Strategic Information Exchange Capabilities and Relationship Quality

This study aims to examine the influence of social customer relationship management (CRM) on relationship quality (RQ); the role of strategic information exchange capabilities (SIECs) as a mediator on the relationship between dimensions of social CRM and RQ was also investigated. A self-structured questionnaire survey was conducted on the subordinates working at various family-style restaurants in Egypt. Following a simple random sampling procedure, 466 valid responses were used for data analysis. The findings reveal that three dimensions of social CRM, namely customer service quality (CSQ), integrated marketing channels (IMCs), and online communities (OCs), have statistically significant effects on RQ. Moreover, SIECs mediate the relationship between CS/IMCs/OCs and RQ. The other two dimensions, rewards (RDs) and value-added services (VSs), do not directly or indirectly affect RQ. This study opens new avenues in the existing literature by identifying the most relevant factors affecting RQ in the context of Egyptian restaurants. This study can enable policymakers and restaurant owners to formulate social CRM strategies and achieve customer satisfaction properly. This study explores the mediation mechanism of SIECs on the relationship between dimensions of social CRM and RQ.

Stakeholder pressure and circular supply chain practices: Moderating roles of environmental information exchange capability and circular innovation orientation

AbstractThis study deploys institutional theory and Resource orchestration theory (ROT) to examine the roles supply chain stakeholder pressure, circular innovation orientation (CIO) and environmental information exchange capability (EIEC) play in adopting Circular supply chain (CSC) practices. This study uses a partial least square structural equation modelling (PLS‐SEM) to analyse survey data gathered from 290 managers of manufacturing Small and medium enterprises (SMEs) in Ghana. This study finds that pressure from supply chain stakeholders substantially drives manufacturing SMEs' CSC practices. This study confirms that EIEC negatively moderates the relationship between supply chain stakeholder pressure and CSC practices. Finally, this study confirms the complementarity between CIO and EIEC through moderating effects between supply chain stakeholder pressure and CSC practices. This study advances circular supply chain management (CSCM) literature by testing a research framework that examines important but rarely studied roles of CIO and EIEC in SMEs' CSC practices adoption under supply chain stakeholder pressure through institutional and resource orchestration perspectives.

Effects of resource orchestration, strategic information exchange capabilities, and digital orientation on innovation and performance of hotel supply chains

Supply chain (SC) innovation has become a competitive source for hotels to enhance performance in the turbulent business environment. Drawing on the resource orchestration (RO) and information sharing (IS) theories, we propose an integrated theoretical framework delineating how strategic information exchange (SIE) and RO capabilities and digital orientation of a hotel foster innovation and enhance the performance of its SC. Based on PLS-SEM analysis of data collected from 281 hotels in the United Arab Emirates, our findings indicate that RO and SIE capabilities of hotels influence the performance of SCs, whereas SC innovation mediates the said relationships. However, contrary to the expectations, digital orientation did not moderate the relationships between RO and SIE capabilities and SC innovation of hotels.

Synchronous and Fully Steerable Active Particle Systems for Enhanced Mimicking of Collective Motion in Nature.

The collective motion observed in living active matter, such as fish schools and bird flocks, is characterized by its dynamic and complex nature, involving various moving states and transitions. By tailoring physical interactions or incorporating information exchange capabilities, inanimate active particles can exhibit similar behavior. However, the lack of synchronous and arbitrary control over individual particles hinders their use as a test system for the study of more intricate collective motions in living species. Herein, a novel optical feedback control system that enables the mimicry of collective motion observed in living objects using active particles is proposed. This system allows for the experimental investigation of the velocity alignment, a seminal model of collective motion (known as the Vicsek model), in a microscale perturbed environment with controllable and realistic conditions. The spontaneous formation of different moving states and dynamic transitions between these states is observed. Additionally, the high robustness of the active-particle group at the critical density under the influence of different perturbations is quantitatively validated. These findings support the effectiveness of velocity alignment in real perturbed environments, thereby providing a versatile platform for fundamental studies on collective motion and the development of innovative swarm microrobotics.

Information as a circular resource – facilitating information exchange to extend product-life

PurposeThis paper aims to study a circular economy business model that offers services with embedded information exchange capabilities to extend product life through maintenance and repair. Information exchange has been identified as a critical factor in advancing the principles of a circular economy, and this research was conducted to illustrate how information exchange can facilitate maintenance and repair.Design/methodology/approachThe study has a case study approach of collecting data through semi-structured interviews and questionnaires.FindingsInformation exchange on what and when to do something engages end-users in maintenance and facilitates learning. For repair, the problem description and possible solutions are information that must be exchanged. Both types of information exchange are facilitated by simple tech solutions relying on known and inexpensive technology (e.g. e-mail service, video call and text messaging).Research limitations/implicationsThe study contributes to the organisational development and knowledge management fields with novel insights on how information exchange and circular economy are related and can be facilitated.Practical implicationsThe study provides insights for companies looking for solutions on how to generate revenue from services and reduce resource consumption. The findings of the study suggest that the development of circular business models does not always require expensive high-tech solutions.Originality/valueTo the best of the authors’ knowledge, this study is unique as it is empirically based on insights into how information exchange can extend product life through the use of simple digital tools.

LGI Net: Enhancing local-global information interaction for medical image segmentation

Medical image segmentation is a critical task used to accurately extract regions of interest and pathological areas from medical images. In recent years, significant progress has been made in the field of medical image segmentation using deep learning and neural networks. However, existing methods still have limitations in terms of fusing local features and global contextual information due to the complex variations and irregular shapes of medical images. To address this issue, this paper proposes a medical image segmentation architecture called LGI Net, which improves the internal computation to achieve sufficient interaction between local perceptual capabilities and global contextual information within the network. Furthermore, the network incorporates an ECA module to effectively capture the interplay between channels and improve inter-layer information exchange capabilities. We conducted extensive experiments on three public medical image datasets: Kvasir, ISIC, and X-ray to validate the effectiveness of the proposed method. Ablation studies demonstrated the effectiveness of our LGAF, and comparative experiments confirmed the superiority of our proposed LGI Net in terms of accuracy and parameter efficiency. This study provides an innovative approach in the field of medical image segmentation, offering valuable insights for further improvements in accuracy and performance. The code and models will be available at https://github.com/LiuLinjie0310/LGI-Net.

A decentralized learning strategy to restore connectivity during multi-agent formation control

In this paper, we propose a decentralized learning algorithm to restore communication connectivity during multi-agent formation control. The time-varying connectivity profile of a mobile multi-agent system represents the dynamic information exchange capabilities among agents. While connected to the neighbors, each mobile agent in the proposed scheme learns to raise the team connectivity. When the inter-agent communication is lost, the associated trained neural network generates appropriate control actions to restore connectivity. The proposed learning technique leverages an adaptive control formalism, wherein a neural network tries to mimic the negative gradient of a value that relies on the agent-to-neighbor distances. All agents use the conventional consensus protocol during the connected multi-agent dynamics, and under communication loss, only the lost agent executes the neural network predicted actions to come back to the fleet. Simulation results demonstrate the effectiveness of our proposed approach for single/multiple agent loss even in the presence of velocity disturbances.

Синтез бортовых приемных устройств совмещенной обработки радиолокационных и информационных сигналов беспилотных летательных аппаратов малого класса

The synthesis of a device for synchronous reception of radar signals, in the parameters of which information messages are integrated, has been carried out. The proposed approach is relevant for increasing the information exchange capabilities under the conditions of limited onboard small class unmanned aerial vehicles resources, critical to the mass of target loads, their power consumption and electromagnetic compatibility. The consecutive implementation of the proposed approach, based on the theory of joint filtering of discrete random and continuous Markov sequences is considered. It makes possible to synthesize an algorithm for a quasi-coherent receiver’s operation of discrete radio signals with the intra-pulse keying against the white noise background. The noise immunity characteristics of the receiver synchronization system were calculated, allowing for a given transmitter power to appropriately select the synchronized generator parameters and vice versa. The feature and advantage of the synthesized synchronization system is a implementation of the accumulation principle when receiving clock pulses.

Eliciting Requirements for a Diabetes Self-Management Application for Underserved Populations: A Multi-Stakeholder Analysis

Medically underserved communities have limited access to effective disease management resources in the U.S. Mobile health applications (mHealth apps) offer patients a cost-effective way to monitor and self-manage their condition and to communicate with providers; however, current diabetes self-management apps have rarely included end-users from underserved communities in the design process. This research documents key stakeholder-driven design requirements for a diabetes self-management app for medically underserved patients. Semi-structured survey interviews were carried out on 97 patients with diabetes and 11 healthcare providers from medically underserved counties in South Texas, to elicit perspectives and preferences regarding a diabetes self-management app, and their beliefs regarding such an app’s usage and utility. Patients emphasized the need for accessible educational content and for quick access to guidance on regulating blood sugar, diet, and exercise and physical activity using multimedia rather than textual forms. Healthcare providers indicated that glucose monitoring, educational content, and the graphical visualization of diabetes data were among the top-rated app features. These findings suggest that specific design requirements for the underserved can improve the adoption, usability, and sustainability of such interventions. Designers should consider health literacy and numeracy, linguistic barriers, data visualization, data entry complexity, and information exchange capabilities.

Survey of Information Exchange and Advanced Use of Other Health Information Technology in Primary Care Settings: Capabilities In and Outside of the Safety Net.

Advanced use of health information technology (IT) functionalities can support more comprehensive, coordinated, and patient-centered primary care services. Safety net practices may benefit disproportionately from these investments, but it is unclear whether IT use in these settings has kept pace and what organizational factors are associated with varying use of these features. The aim was to estimate advanced use of health IT use in safety net versus nonsafety net primary care practices. We explore domains of patient engagement, population health management (decision support and registries), and electronic information exchange. We examine organizational characteristics that may differentially predict advanced use of IT across these settings, with a focus on health system ownership and/or membership in an independent practice network as key factors that may indicate available incentives and resources to support these efforts. We conduct cross-sectional analysis of a national survey of physician practices (n=1776). We use logistic regression to predict advanced IT use in each of our domains based on safety net status and other organizational characteristics. We then use interaction models to assess whether ownership or network membership moderate the relationship between safety net status and advanced use of health IT. Health IT use was common across primary care practices, but advanced use of health IT functionalities ranged only from 30% to 50% use. Safety net settings have kept pace with adoption of features for patient engagement and population management, yet lag in information exchange capabilities compared with nonsafety net practices (odds ratio=0.52 for federally qualified health centers, P<0.001; odds ratio=0.66 for other safety net, P=0.03). However, when safety net practices are members of a health system or practice network, health IT capabilities are comparable to nonsafety net sites. All outpatient settings would benefit from improved electronic health record usability and implementation support that facilitates advanced use of health IT. Safety net practices, particularly those without other sources of centralized support, need targeted resources to maintain equitable access to information exchange capabilities.

Association between 30-day readmission rates and health information technology capabilities in US hospitals.

Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.

Co-creating business value through IT-business operational alignment in inter-organisational relationships: empirical evidence from regional networks

ABSTRACT IT alignment research has remained limited primarily to intra-organisational alignment, leaving much to learn about the value-creation potential of its largely neglected inter-organisational counterpart. This study addresses this gap by investigating the role of IT-business operational alignment in inter-organisational relationships (IOR). Drawing on IT-based value-co creation and IT alignment literature, we propose that IOR IT-business operational alignment is an immediate source for co-creating business value and can be established through a capability-building process. Using a sample of 241 regional network collaborations in Germany, we find that IOR IT-business operational alignment directly affects relationship performance. Moreover, we find that three IOR IT capabilities – IT infrastructure integration, information exchange capability, and IT-enabled coordination – enable the development of IOR IT-business operational alignment. This study contributes to IS research on value co-creation by integrating the concept of IT-business alignment into a nomological network with well-established IOR IT capabilities. We provide theoretical explanations and empirical evidence that IT infrastructure integration, information exchange capability, and IT-enabled coordination indirectly affect relationship performance over an operational alignment process. For practice, we highlight the importance of monitoring IT-business operational alignment in IOR and provide recommendations on how to expand existing alignment efforts.

REQUIREMENTS FOR OPTICAL TRANSPORT NETWORKS FOR SUCCESSFUL IMPLEMENTATION OF 5G TECHNOLOGY

Background. The amount of data generated, transmitted and accumulated in the world is constantly growing every year. On the other hand, users need new services and information exchange capabilities. 5G technology is able to meet the requirements of subscribers to some extent. Therefore, it is important to consider the main features of fifth generation mobile networks and to determine the requirements for the design of optical transport networks that will ensure the successful implementation of 5G technology.Objective. The aim of the paper is to determine the features of design and characteristics of optical transport networks to implement the capabilities of 5G technology.Methods. The analysis of the publications devoted to modern optical networks and their optical components allowed defining the basic requirements to design of optical transport networks and their characteristics.Results. It is established that optical transport networks should provide increased bandwidth; possibility of mass optical cross-connections in ROADM/OXC nodes that support addition/removal of any wavelength from/in any direction; intelligent operation and maintenance of the network.Conclusions. The defined requirements for the design of optical transport networks and their characteristics will ensure the successful implementation of the capabilities of 5G technology, which will meet the needs of subscribers.

Strategic use of health information exchange and market share, payer mix, and operating margins.

Health information exchange (HIE) capabilities are tied to health care organizations' strategic and business goals. As a technology that connects information from different organizations, HIE may be a source of competitive advantage and a path to improvements in performance. The aim of the study was to identify the impact of hospitals' use of HIE capabilities on outcomes that may be sensitive to changes in various contracting arrangements and referral patterns arising from improved connectivity. Using a panel of community hospitals in nine states, we examined the association between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin (2010-2014). Regression models that controlled for the number of different data types shared intraorganizationally and other time-varying factors and included both hospital and time fixed effects were used for adjusted estimates of the relationships between changes in HIE capabilities and outcomes. Increasing HIE capability was associated with a 13 percentage point increase in a hospital's discharges that were covered by commercial insurers or Medicare (i.e., payer mix). Conversely, increasing intraorganizational information sharing was associated with a 9.6 percentage point decrease in the percentage of discharges covered by commercial insurers or Medicare. Increasing HIE capability or intraorganizational information sharing was not associated with increased market share nor with operating margin. Improving information sharing with external organizations may be an approach to support strategic business goals. Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.

Organizational and Market Dynamics Associated with Usable, Accessible Health Information Exchange for Skilled Nursing Facilities

Information discontinuity between hospitals and skilled nursing facilities (SNFs) is a critical barrier to safe and effective transitions. To engage effectively in information sharing, SNFs need structural health information exchange (HIE) capabilities but also HIE design and workflows that result in electronic information actually being accessible and usable at the point of care.We use nationally representative SNF data to identify key facility characteristics, and characteristics of the facility’s top hospital referral partner, that are associated with likelihood of SNFs having access to electronic information sharing tools. Controlling for those capabilities, we then assess the extent to which those same characteristics influence the extent to which the SNF reports usable information received electronically that is actually available at the point of care.We conducted pooled, cross‐sectional survey data analyses. We identified our sample of SNFs through the Office of the National Coordinator SNF Health IT Survey (2016‐2017). From this survey, we generated our SNF HIE capability metric (ability to electronically query for or receive patient information from outside sources) as well as our key study outcome—whether SNFs report usable electronic information from outside sources available at the point of care. Organizational SNF characteristics were pulled from the SK&amp;A Nursing Home datafile as well as the CMS Nursing Home Public Use file.We matched each SNF to the hospital responsible for sending the highest percent of their referrals using Medicare referral pattern data and used these same data to calculate a measure of SNF referral relationship concentration. We then, for each partner hospital, used the American Hospital Association (AHA) IT Supplement to identify general and SNF‐specific HIE capabilities. We use linear probability models to estimate the association between relevant organizational characteristics (of the SNF and partner hospital) and both HIE outcomes: (1) SNF HIE capabilities and (2) SNF self‐reported availability of usable and accessible outside information at the point of care (controlling for HIE capabilities).Nationally representative sample of skilled nursing facilities (N = 1,189).Controlling for the presence of an EHR, SNFs are more likely to electronically query for or receive information from outside sources if they are large (+10.3%, top tertile compared to bottom; P = .004), if they are part of a large chain (+11.7%, member of 70+ nursing home chain, compared to standalone; P = .001), and if their partnering hospital reports having a health information portal (+7.5%; P = .049).Adjusting for SNF HIE capabilities, SNFs have a higher probability of usable electronic information available at the point of care if their top partner hospital reports participation in a community HIO (+7.6%; P = .018).Hospital information portals increase SNF access to HIE infrastructure, but community‐level HIOs increase the likelihood that SNFs actually have accessible, usable electronic information from hospitals at the point of care.Community HIOs appear to play a critical role in SNFs having usable, timely access to outside sources of health information. HIOs have significant opportunity to bolster their value proposition through greater engagement with SNFs and other postacute providers on supporting their informational needs and transitional care processes with hospitals.Office of the National Coordinator for Health IT.

A Mixed Methods Study of the Association of Non-Veterans Affairs Care With Veterans' and Clinicians' Experiences of Care Coordination.

Poor coordination between the Department of Veterans Affairs (VA) and non-VA care may negatively impact health care quality. Recent legislation is intended to increase Veterans' access to care, in part through increased use of non-VA care. However, a possible consequence may be diminished patient experiences of coordination. The objective of this study was to determine VA patients' and clinicians' experiences of coordination across VA and non-VA settings. Observational mixed methods using patient surveys and clinician interviews. Sampled patients were diagnosed with type 2 diabetes mellitus and either cardiovascular or mental health comorbidities. Patient perspectives on coordination were elicited between April and September 2016 through a national survey supplemented with VA administrative records (N=5372). Coordination was measured with the 8-dimension Patient Perceptions of Integrated Care survey. Receipt of non-VA care was measured through patient self-report. Clinician perspectives were elicited through individual interviews (N=100) between May and October 2017. Veterans who received both VA and non-VA care reported significantly worse care coordination experiences than Veterans who only receive care in VA. Clinicians report limited information exchange capabilities, which, combined with bureaucratic and opaque procedures, adversely impact clinical decision-making. VA is working through a shift in how Veterans receive health care by increasing access to care from non-VA providers. Study findings suggest that VA should prioritize coordination of care in addition to access. This could include requiring monitoring of patient-experienced care coordination, surveys of referring and consulting clinicians, and pilot testing and evaluation of interventions to improve coordination.

Health Data Sharing in US Nursing Homes: A Mixed Methods Study

Objectives(1) To understand the extent to which nursing homes have the capability for data sharing and (2) to explore nursing home leaders' perceptions of data sharing with other health care facilities and with residents and family members. DesignExploratory, mixed-methods. Setting and ParticipantsWe conducted a secondary analysis of data from a national survey of nursing home administrative leaders (n = 815) representing every state in the United States. Next, semistructured interviews were used to elicit rich contextual information from (n = 12) administrators from nursing homes with varying data-sharing capabilities. MethodsWe used descriptive statistics along with Rao-Scott chi-square and logistic regression models to examine the relationship between health data–sharing capabilities and nursing home characteristics such as location, bed size, and type of ownership. Qualitative data were analyzed using content analysis. ResultsOf the 815 nursing homes completing the survey, 95% had computerized (electronic) medical records, and 46% had some capability for health information exchange. Nursing homes located in metropolitan areas had 2.53 (95% confidence interval = 1.53, 4.18) times greater odds for having health information exchange capability compared with nursing homes in small towns. Perceived challenges to health data sharing with residents and family members and external clinical partners include variance in systems and software, privacy and security concerns, and organizational factors slowing uptake of technology. Perceived benefits of health data sharing included improved communication, improved care planning, and anticipating future demand. Conclusions and ImplicationsAs health data sharing becomes more ubiquitous in acute care settings, policy makers, nursing home leaders, and other stakeholders should prepare by working to mitigate barriers and capitalize on potential benefits of implementing this technology in nursing homes.

Interoperability Challenges in the Cybersecurity Information Sharing Ecosystem

Threat intelligence helps businesses and organisations make the right decisions in their fight against cyber threats, and strategically design their digital defences for an optimised and up-to-date security situation. Combined with advanced security analysis, threat intelligence helps reduce the time between the detection of an attack and its containment. This is achieved by continuously providing information, accompanied by data, on existing and emerging cyber threats and vulnerabilities affecting corporate networks. This paper addresses challenges that organisations are bound to face when they decide to invest in effective and interoperable cybersecurity information sharing and categorises them in a layered model. Based on this, it provides an evaluation of existing sources that share cybersecurity information. The aim of this research is to help organisations improve their cyber threat information exchange capabilities, to enhance their security posture and be more prepared against emerging threats.

Health information technology for ambulatory care in health systems.

The adoption and use of health information technology (IT) by health systems in ambulatory care can be an important driver of care quality. We examine recent trends in health IT adoption by health system-affiliated ambulatory clinics in the context of the federal government's Meaningful Use and Promoting Interoperability programs. We analyzed a national sample of 17,861 ambulatory clinics affiliated with 1711 health systems, using longitudinal data (2014-2016) from the HIMSS Analytics annual surveys. We used descriptive analyses and linear probability models to examine the adoption of electronic health records (EHRs), as well as 16 specific functionalities, at the clinic level and the system level. We compared the differential trends of adoption by various characteristics of health systems. We find that the adoption of an EHR certified by the Office of the National Coordinator for Health IT (ONC) increased from 73% to 91%. However, in 2016, only 38% of clinics reported having all 16 health IT functionalities included in this study. Small health systems lag behind large systems in ambulatory health IT adoption. Patient-facing functionalities were less likely to be adopted than those oriented toward physicians. Health information exchange capabilities are still low among ambulatory clinics, pointing to the importance of the ONC's recent Promoting Interoperability initiative. The relatively low uptake of health IT functionalities important to care improvement suggests substantial opportunities for further improving adoption of ambulatory health IT even among the current EHR users.

Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.

U.S. policy on interoperable HIT has focused on increasing inter-system (ie, between different organizations) health information exchange. However, interoperable HIT also supports the movement of information within the same organization (ie, intra-system exchange). We examined the relationship between hospitals' intra- and inter-system information exchange capabilities among health system hospitals included in the 2010-2014 American Hospital Association's Annual Health Information Technology Survey. We described the factors associated with hospitals that adopted more intra-system than inter-system exchange capability, and explored the extent of new capability adoption among hospitals that reported neither intra- or inter-system information capabilities at baseline. The prevalence of exchange increased over time, but the adoption of inter-system information exchange was slower; when hospitals adopt information exchange, adoption of intra-system exchange was more common. On average during our study period, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Controlling for other factors, hospitals exchanged more types of information in an intra-system manner than inter-system when the number of different inpatient EHR vendors in use in health system is larger. Consistent with the U.S. goals for more widely accessible patient information, hospitals' ability to share information has increased over time. However, hospitals are prioritizing within-organizational information exchange over exchange between different organizations. If increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals' motivations for pursuing an intra-system-information-exchange-first strategy.